Spirituality as a universal concept: Student experience of learning about spirituality through the medium of art

Spirituality in Adolescents and Young Adults With Cancer: An Evolutionary Concept Analysis

Background: Despite an increased focus on the importance of spirituality to human health, including adolescent health outcomes there remains an absence of evidence-based programs to address the spiritual needs of patients and families. A critical barrier is the absence of a clear conceptual understanding and operational definitions of spirituality for adolescents/young adults (AYAs) with cancer. The purposes of this concept analysis were to (a) clarify the concept of spirituality in the context of the AYAs' cancer experience and (b) generate a definition based on a review of the literature examining spiritual development and the role of spirituality in AYAs' health and cancer treatment. Method: We used Roger's evolutionary concept analysis method to identify antecedents, attributes, and consequences of spirituality in the context of AYAs' cancer using thematic analysis and included identification of case exemplars. Results: Of the 86 articles identified, 21 met our inclusion criteria. Analysis revealed four attributes of spirituality in AYAs with cancer: meaning and purpose, connectedness, life-long universal experience, and independent of or related to religion and faith traditions. Identified antecedents included the presence of spiritual resources, chronic illness, belief, or wonder about a higher power, and existential questions. Identified consequences included hope, meaning, feelings of peace, and enhanced well-being and illness acceptance. Based on the findings, we generated a definition of spirituality in AYAs with cancer. Discussion: Findings inform the development of measures and spiritual care interventions specific to AYAs with cancer. An important limitation to address in future research is the absence of AYAs' first-person accounts of their own spirituality.

Factors affecting spiritual care competency of mental health nurses: a questionnaire-based cross-sectional study

BACKGROUND

Although providing spiritual care is an important part of holistic nursing care for psychiatric patients, factors associated with spiritual care competency in mental health nurses remain unclear. The aim of our study was to explore a possible association of personal and external factors with spiritual care competency in mental health nurses.

METHODS

This prospective questionnaire-based cross-sectional study was conducted by inviting mental health nurses from mental health hospitals and tertiary referral centers. Personality traits and spiritual care competency were assessed by using [1] "big-five Mini-Markers" questionnaire, and [2] spiritual care competency scale, respectively. From the 250 mental health nurses being invited, 239 valid questionnaires were valid for final analysis. Statistical analyses including descriptive statistics, ANOVAs, t-tests, and hierarchical multiple regression models were used to investigate the associations between personal/external factors and their spiritual care competency in mental health nurses.

RESULTS

The mean age of the 239 participants was 35.96 ± 8.11 and the mean years of working experience was 9.41 ± 7.06. Over 90% of them had no experience of providing spiritual care. There were significant positive correlations of spiritual care competency with the experience of delivering spiritual care (p < 0.001), previous participation in spiritual care education programs (p = 0.045), a longer working experience (p = 0.014), and a higher education level (postgraduate vs. college, p = 0.006), as well as the personality components of "Conscientiousness" (p < 0.001), "Agreeableness" (p < 0.001), "Extraversion" (p = 0.03), and "Openness/Intellect" (p < 0.001).

CONCLUSIONS

Both personal and external factors may be related to the self-perception of spiritual care competency among mental health nurses. These findings may help mental health nurses understand the possible positive and negative associations of their personality components with their spiritual care abilities. Moreover, our identification of the positive impacts of educational programs and previous experience of spiritual care on spiritual care competency may underscore the importance of tailoring appropriate training programs to cater for the individual needs of mental health nurses.

Impacts of extrinsic and intrinsic factors on psychiatric nurses' spiritual care attitudes

WHAT IS KNOWN ON THE SUBJECT?: Because the definition of spirituality is complex and has cultural and individual dimensions, it is important to be receptive to individual differences in the perception of spirituality during clinical practice of mental health nurses. Although enhancing spiritual care is beneficial to patients diagnosed with mental illnesses, the extrinsic (e.g., education) and intrinsic factors that would affect nurses' attitudes towards spiritual care have not been investigated. Notwithstanding the known impact of certain intrinsic factors (e.g., personality-related) of mental health nurses on their coping strategies as well as their emotional and mental health, the link to their spiritual care attitudes has received little attention. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper is the first to identify the beneficial impacts of extrinsic factors including postgraduate education, working experience, participation in palliative care education programmes, and spiritual care experience on spiritual care attitudes among mental health nurses. Certain intrinsic factors, including those personality-related such as "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness," were also associated with higher awareness of providing spiritual care among mental health nurses. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The finding of an association of certain intrinsic factors with more positive attitudes towards spiritual care could encourage further studies to explore possible links between these factors and attitudes of spiritual care. Those less aware of the patients' spiritual needs may benefit through participating in relevant education and on-the-job training programmes that involves actual practice and collaboration in a multidisciplinary team. ABSTRACT: Introduction Although enhancing spiritual care can facilitate the communication of mental health nurses with patients diagnosed with mental illnesses, extrinsic and intrinsic factors that may influence their spiritual care attitudes remain unclear. Aim To conduct a questionnaire-based survey on mental health nurses from eight hospitals. Method A total of 239 psychiatric nurses were assessed based on (1) "big-five Mini-Markers" questionnaire and (2) spiritual care attitudes scale on three components (i.e., core values, growth, and nursing) to investigate the associations of spiritual care attitudes with social/occupational characteristics and personality. Results A positive attitude was significantly associated with working experience, higher educational level, previous participation in palliative care education programmes, spiritual care experience, and personality factors including "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness." Discussion Despite demonstrating impacts of intrinsic factors (e.g., personality) on mental health nurses' spiritual care attitudes, other modifiable extrinsic factors (e.g., education) were important in enhancing their awareness towards spiritual care. Implications for Practice Our findings encourage further studies to explore possible links between intrinsic factors and attitudes of mental health nurses towards spiritual care as well as suggest benefits of continuing education and on-the-job training that involves actual practice and collaboration in a multidisciplinary team to provide spiritual care.

Nurse’s spiritual care competence in Ethiopia: A multicenter cross-sectional study

Background

Many health care professionals emphasize that spirituality is an important factor in overall health. Although spiritual practices are vital to health, spirituality has received little emphasis in nursing. Hence, the study’s purpose has been to evaluate the current state of spiritual care competence and the factors that influence it among nurses in Southwest Ethiopia.

Methods

From July 1 to 20, 2021, nurses at five hospitals in southwest Ethiopia were enrolled in a facility-based cross-sectional study. The study subjects were chosen using a systematic random sampling. A self-administered questionnaire was undertaken to gather the data. Epi Data 3.1 was used to code the dataset, and SPSS version 25 was used for analysis. To identify factors associated with spiritual care competence, researchers performed bivariate and multivariable linear regression analyses. The significance level was set at p<0.05.

Results

Three hundred sixty-seven nurses attended in the study, giving a 91.06, percent rate of response. The mean spiritual care competence score among healthcare professionals was 3.14±0.74. Age (p<0.05), and training in spiritual care (p<0.05) were significantly associated with spiritual care competence.

Conclusions

Spiritual care competence was moderate among the nurses. Spiritual care competence varies in accordance with a number of factors, including age, and training in spiritual care. Nurses are better suited to focus on the spiritual health of clients, which necessitates the provision of spiritual care competence training for nurses.

Defining Spirituality in Healthcare: A Systematic Review and Conceptual Framework

Objective: To investigate the definitions of spirituality in the healthcare field, identifying its main dimensions and proposing a framework that operationalizes the understanding of this concept. Methods: This is a systematic review following the PRISMA guideline (PROSPERO: CRD42021262091), searching for spirituality definitions published in scientific journals. Searches were carried out in PubMed (all articles listed up to October 2020) and in the reference lists of the articles found in the database, followed by selection under specific eligibility criteria. Results: From a total of 493 articles, 166 were included in the final analysis, showing that there is a large body of scientific literature proposing and analyzing spirituality definitions. In these articles, 24 spirituality dimensions were found, most commonly related to the connectedness and meaning of life. Spirituality was presented as a human and individual aspect. These findings led us to construct a framework that represents spirituality as a quantifiable construct. Conclusions: Understanding spirituality is an important aspect for healthcare research and clinical practice. This proposed framework may help to better understand the complexity of this topic, where advances are desirable, given the relevance it has acquired for integral health care.

StARTalking: An Arts and Health Program to Support Undergraduate Mental Health Nursing Education

Community arts and health programs are recognized as powerful contributors to mental health and wellbeing, reducing social isolation and strengthening community connection. They attract individuals with diverse lived experience and are invaluable learning environments for consumers and undergraduate mental health nursing students. This paper reports on the evaluation of StARTalking, a community arts and health program in Melbourne, Australia. The study aimed to better understand the consumer and student experience participating in the program. The themes, Finding connection/Taking time out, clearly indicate that embedding arts and health in mental health nursing education supports consumer and student learning, health and wellbeing.

Approaching Spiritual and Existential Care Needs in Health Education: Applying SOPHIE (Self-Exploration through Ontological, Phenomenological, and Humanistic, Ideological, and Existential Expressions), as Practice Methodology

Addressing existential and spiritual care needs, often remains a challenge in health education. Spirituality is a subjective human experience that shapes how individuals make meaning, construct knowledge, develop their own sense of reality, and bring personal and social transformation. To inspire health and social students at a London based University; learners were engaged into philosophical reasonings associated with the meaning to care. SOPHIE (Self-exploration through Ontological, Phenomenological and Humanistic, Ideological, and Existential expressions)—a reflective practice tool was applied during in-class activities from June 2019–2020. Using SOPHIE as a tool, students were encouraged to explore existential and ontological care aspects by engaging into transformative learning approaches. Participants identified their own existential and spiritual care needs by reflecting on their own meaning making process. SOPHIE enabled resilience and authenticity among learners as a reflexive discourse.

Developing a spiritual care competency framework for pre-registration nurses and midwives

This paper identifies competencies in spiritual care from an in-depth literature review and develops a theoretical framework for competencies in spiritual care. It forms part of a larger modified Delphi study which recruited international nursing/midwifery experts. Using Braun and Clark (2006) adapted six-phase content thematic analysis, 7 domains and 116 competency items were generated from an in-depth literature review in three areas; spirituality and spiritual care, spiritual care education, and spiritual care curricular contents.

“Enablement”—Spirituality Engagement in Pre-Registration Nurse Education and Practice: A Grounded Theory Investigation

Historically, spirituality in nursing was considered a fundamental dimension, contributing to patients’ wellbeing. Accordingly, nurses are expected to attend to the spiritual needs of patients as a part of holistic nursing care, and pre-registration nurse education (that is undergraduate nurse education) has a responsibility to equip them to fulfil this aspect of their role. However, the content of spirituality in nurse education programmes lack structure and consistency, hence further investigation into the value of such education and its transferability in clinical practice is needed. Data collection was by individual interviews with 13 pre-registration participants undertaking adult nursing between March 2012 and May 2014. Each interview was digitally recorded and transcribed verbatim. Through theoretical sampling, data collection and analysis occurred in a cyclical manner until theoretical saturation/sufficiency was reached. The participants’ main concerns were: explaining spirituality, remembering spirituality education and content, and uncertainties about facilitating patients’ spiritual needs; these combine to form ‘having sufficient spirituality education to facilitate patients’ spiritual needs’. The substantive theory of ‘Enablement’ (make possible) was constructed to explain how the participants resolved their main concern. This investigation reveals how the participants acquire and translate spirituality education to practice, so realising holistic care.

Effectiveness and experience of arts-based pedagogy among undergraduate nursing students: a mixed methods systematic review

BACKGROUND

To develop well rounded professional nurses, educators need diverse pedagogical approaches. There is growing interest in arts-based pedagogy (ABP) as the arts can facilitate reflection, create meaning and engage healthcare students. However, the emerging body of research about ABP needs to be systematically examined.

OBJECTIVES

To synthesize the best available evidence on the effectiveness of ABP in enhancing competencies and learning behaviors in undergraduate nursing education and to explore nursing students' experiences with art-based pedagogy.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

The review considered studies that included participants who are undergraduate nursing students.

TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST

The qualitative (QL) component considered studies investigating nursing students' experiences of ABP, and the quantitative (QN) component considered studies evaluating the effectiveness of ABP in undergraduate nursing education.

TYPES OF STUDIES

The QL component considered QL studies including designs such as phenomenology, grounded theory, ethnography, action research and feminist research. The QN component considered studies that examined the effectiveness of ABP including designs such as randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies, analytical cross-sectional studies, case series, individual case reports and descriptive cross-sectional studies.

OUTCOMES

The following QN outcomes of ABP were assessed: knowledge acquisition, level of empathy, attitudes toward others, emotional states, reflective practice, self-transcendence, cognitive/ethical maturity, learning behaviors and students' perspectives of ABP.

SEARCH STRATEGY

An extensive three-step search strategy was conducted for primary research studies published between January 1, 1994 and April 7, 2015. The strategy included searching CINAHL, MEDLINE, ERIC, PsycINFO, Academic Search Complete, Arts and Humanities Citation Index, Art Full Text, Scopus, ProQuest Dissertations and Theses, A&I, and gray literature. Only studies published in English were included.

METHODOLOGICAL QUALITY

Two reviewers assessed all studies for methodological quality using appropriate critical appraisal checklists from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) or the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).

DATA EXTRACTION

Data were extracted from included articles using the standardized data extraction tool from JBI-QARI or JBI-MAStARI.

DATA SYNTHESIS

Qualitative studies were pooled through a meta-synthesis. Data from the QN studies were combined using a narrative synthesis as a meta-analysis was not possible. The researchers used a segregated mixed methods approach to integrate the QL and QN components.

RESULTS

Twenty-one QL studies of high methodological quality were included. The two synthesized findings revealed that art forms could create meaning and inspire learning in undergraduate nursing education and that ABP can develop important learner outcomes/competencies for professional nursing. These synthesized findings received a moderate ConQual rating. Fifteen experimental/quasi-experimental studies of moderate methodological quality were included. The narrative synthesis suggested that ABP improved nursing students' knowledge acquisition, level of empathy, attitude toward others, emotional states, level of reflective practice, learning behaviors and aspects of cognitive/ethical maturity. In five cross-sectional studies, the majority of students had a positive perspective of ABP. When the QL and QN findings were interpreted as a whole, ABP appeared to facilitate learning in the cognitive and affective domains and may be especially useful in addressing the affective domain.

CONCLUSION

Nurse educators should consider using ABP as students found that this approach offered a meaningful way of learning and resulted in the development of important competencies for professional nursing. The QN studies provide a very low level of evidence that ABP improved students' knowledge acquisition, level of empathy, attitude toward others, emotional states, level of reflective practice, learning behaviors and aspects of cognitive/ethical maturity. Although the QN findings can inform future research, the evidence is not robust enough to demonstrate improved outcomes.

Studying the old masters of nursing: A critical student experience for developing nursing identity

In the past professional identity in nursing was inculcated in students alongside institutional pride. A strong sense of professional identity is key to staff retention and recruitment and key to the delivery of quality nursing care. With the wholesale transfer of pre-registration nursing education to the third level sector, however, the reality is that students now divide their affiliations between university and healthcare institutions and professional identity development may be stymied. For this reason, there is need to explore alternative means of developing professional identity. Exposure to nursing history may counteract this tendency. Based on adult nursing students' reflections of a visit to the Florence Nightingale Museum, we discuss the potential of this activity in aiding development of critical professional identity.

Reliability and Validity of the Spiritual Care-Giving Scale in a Turkish Population

This study aimed to adapt an English version of the survey tool Spiritual Care-Giving Scale for Turkish students and to evaluate its psychometric properties. Spiritual care is a central element of holistic nursing, but is not often made explicit in the theoretical and practical components of preregistration nursing programs. A composite scale will assist in identifying students' perceptions and issues to be addressed in curricula and practice settings in Turkey. The scale was composed of 35 items and five subscales. Cronbach's α reliability coefficient was .96, and item-total point correlations were between .37 and .77. In addition, split-half reliability coefficient was .88. The Spiritual Care-Giving Scale was found to be a valid and reliable instrument for measuring the multifaceted perspectives of spirituality and spiritual care in practice by students. Further testing of this scale is required with other student populations and clinicians.

Iranian nurses’ professional competence in spiritual care in 2014

Background:

The holistic approach views the human as a bio-psycho-socio-spiritual being. Evidence suggests that among these dimensions, the spiritual one is largely ignored in healthcare settings.

Objectives:

This study aimed to evaluate Iranian nurses’ perceived professional competence in spiritual care, the relationship between perceived competence and nurses’ personal characteristics, and barriers to provide spiritual care.

Research design:

A cross-sectional study was conducted in the year 2014.

Participants and research context:

The study population consisted of nurses working in teaching hospitals in Kashan city. Using a stratified, systematic random method, 250 samples were selected from a total of 1400 nurses. An indigenous instrument was used to assess the nurses’ competencies in spiritual care.

Ethical considerations:

A research ethics committee approved the study. All the participants were briefed on the study aims, were assured of the confidentiality of their personal information, and signed a written informed consent.

Results:

Among a total of 250 nurses, 239 answered the questionnaire completely, and in total, 23%, 51%, and 26% had poor, moderate, and favorable competence in spiritual care, respectively. No significant differences were found between the mean competence scores of spiritual care in terms of gender, marital status, employment status, and level of qualification. Significant difference was found between nurses’ overall score of competence in spiritual care and receiving training on spiritual care, nurses’ position, and the ward they worked in.

Discussion:

Confirming the findings of the international literature, this study puts light on the situation of nurses’ perceived competence and barriers to providing spiritual care in Iran as an eastern and Islamic context.

Conclusion:

Three-quarters of the nurses had moderate or unfavorable competence in spiritual care. Due to the crucial role of spiritual care in quality of care and patient satisfaction, nurses should be trained and supported to provide spiritual care.

Spirituality in pre-registration nurse education and practice: A review of the literature

Spirituality is known to be an integral part of holistic care, yet research shows that it is not well valued or represented in nurse education and practice. However, the nursing profession continues to make efforts to redress the balance by issuing statements and guidance for the inclusion of spirituality by nurses in their practice. A systematic literature review was undertaken and confirms that nurses are aware of their lack of knowledge, understanding and skills in the area of spirituality and spiritual care, and desire to be better informed and skilled in this area. Consequently, in order for nurses to support the spiritual dimension of their role, nurse education has a vital part to play in raising spiritual awareness and facilitating competence and confidence in this domain. The literature review also reveals that studies involving pre-registration are few, but those available do provide examples of innovation and various teaching methods to deliver this topic in nursing curricular.

Recovery based on spirituality in substance abusers in Iran

Background and Purpose:

Spirituality is an important factor influencing the decrease of substance abuse severity and maintenance of the recovery phase. This research, investigates the effect of spiritual experiences in the recovery of substance abusers.

Material and Methods:

Qualitative data was collected from 16 men and 6 women, selected through purposeful sampling to ensure an equilibrated gender representation and data from different recovery periods. Data were collected via semi-structured interviews.

Results:

Data showed two main categories: “Mutual relationship between spirituality and recovery,” divided into four subcategories: religious background, religious teachings, experience exchange, and support of family and society; and “A new perspective toward life” subdivided into access to calmness and spiritual development. A factor “spirituality meaning religion” arose repeatedly throughout the study.

Conclusion:

The results of this study can be useful for policy makers, care providers, families, and drug addicts. The promotion of spirituality in substance abusers can help in their struggle with temptation. Effective strategies to ensure drug abstinence and maintenance of the recovery phase are encouraging substance abusers and their families to participate in spirituality-based psychotherapy sessions held in addiction treatment centers, multi-disciplinary cooperation among the organizations involved in the addiction phenomenon, and training the families regarding the importance of spirituality in the mental health of their children through mass media.

The efficacy of integrating spirituality into undergraduate nursing curricula

Background:

Attention to patients’ spirituality, as a moral obligation of care, is now widely accepted in nursing practice. However, until recently, many nursing programs have paid little attention to spirituality.

Objective:

The objective of this study was to identify the impact of two different curricula, used to teach undergraduate nursing students, on increasing nursing student awareness of spirituality in the care of patients.

Research design:

A quasi-experimental post-intervention two-group design was conducted in 2009–2010 and 2010–2011 academic years.

Participants and research context:

The study included a total of 130 volunteer senior-year students. The students were assigned as “the intervention group/integrated system” that were informed about spirituality or as “the control group/traditional system” that received no information on spirituality. Data were collected via a personal information form and the Spirituality and Spiritual Care Rating Scale was used to assess responses. The study was conducted at the Department of Nursing of the Faculty of Health Sciences, Cumhuriyet University, in Central Anatolia/Turkey.

Ethical considerations:

Permission to conduct the study at the nursing school was obtained from the schools’ management teams. The rights of the participants were protected in this study by obtaining informed consent.

Findings:

The results revealed that the intervention group had a higher mean score on the Spirituality and Spiritual Care Rating Scale than did the control group. The students in the intervention group defined the terms of spirituality and spiritual care more accurately than did the control group students.

Discussion:

Nurses are professionally and ethically responsible for providing spiritual care. Nurses’ competence in meeting the spiritual needs of their patients should be improved by undergraduate education on spiritual care. Nursing scholars reported a significant difference in the knowledge and attitudes toward spirituality of nursing students as a result of the integration of spirituality into the undergraduate nursing curriculum.

Conclusion:

Spirituality should be more widely included in nursing education.

Iranian cancer patients' perception of spirituality: a qualitative content analysis study

Background

Spirituality is a subjective and multi-dimensional concept. The ambiguity in its meaning can create barriers in its application in both education and medicine. The present study aimed to explore the Iranian cancer patients’ perception of spirituality.

Methods

A qualitative study, using the content analysis approach, was conducted. Semi-structured interviews were held with 11 cancer patients and six members of their families in one of Tehran’s hospitals and a charity institute. The data generated were transcribed verbatim and content analysis approach was used for data reduction, naming data, obtaining analytical code and determining categories and themes.

Results

Three themes (and seven sub-themes) emerged from the data analysis: 1) God as the spiritual truth (relationship with God and trust in God), 2) Moralities as a spiritual sign (considering personal and social moral codes) and 3) Spiritual resources as the source of hope (religious, personal and social resources).

Conclusions

Overall, in the view of cancer patients, spirituality can be defined in a religious context. However, some of them believe in morality beside religiosity, so health care staff must pay due attention to these aspects, to provide them with the opportunity to use spiritual resources.

Singapore nursing students' perceptions and attitudes about spirituality and spiritual care in practice: a qualitative study

PURPOSE

This exploratory study investigated nursing students' perceptions and attitudes about spirituality and spiritual care in practice.

STUDY DESIGN

A qualitative interpretative approach was used to investigate the research question.

METHOD

In-depth interviews were conducted with 16 final-year preregistration nursing students from 3 different educational institutions offering a degree or diploma program in Singapore. Data were analyzed using the Miles and Huberman's method of thematic analysis.

FINDINGS

Thematic analysis identified three themes: (a) students' perceptions of spirituality, (b) spiritual care, and (c) factors influencing spiritual care in practice.

CONCLUSIONS

The study informed that though young, spirituality matters to the nursing students. Accordingly, nursing is perceived to play an integral role in spiritual care. Enabling factors need to be systematically addressed both in the education and practice arenas before the perennial issue of disconnect between development and implementation of spirituality in practice can be bridged.

Development and preliminary validation of a composite Spiritual Care-Giving Scale

BACKGROUND

Spiritual care is a central element of holistic nursing, but is not often made explicit in the theoretical and practical components of pre-registration nursing programmes. A composite scale will assist in identifying students' perceptions and issues to be addressed in curricula and practice settings.

OBJECTIVE

To develop and test the Spiritual Care-Giving Scale that measures student nurses' perceptions towards spirituality and spiritual care.

METHOD

Following a critical review of the literature, review by an expert panel and a pilot study, the SCGS, was administered to a convenience sample of final-year nursing students. Participants also completed the Spirituality and Spiritual Care Rating Scale and Student Survey of Spiritual Care to assess construct validity. Internal reliability was assessed using Cronbach's alpha and test-retest reliability was assessed at 1 week. Principal component analysis was used and the 68-item Spiritual Care-Giving Scale was reduced to 35-items.

RESULTS

745 (out of 1204) students completed the survey giving a 61.9% response rate. A 5-factor solution explaining 61.2% of the variance was supported. Cronbach's alpha of the 35-item scale was 0.86 and test-retest reliability was stable over time (r=0.811). Concurrent validity with the Spirituality and Spirituality Care Rating scale (r=0.587, p<0.01) and Student Survey of Spiritual Care (r=0.507, p≤0.01) showed significant correlation.

CONCLUSION

The Spiritual Care-Giving Scale was found to be a valid and reliable instrument for measuring the multifaceted perspectives of spirituality and spiritual care in practice by students. Further testing of this scale is required with other student populations and clinicians.

Why Iranian married women use withdrawal instead of oral contraceptives? A qualitative study from Iran

BACKGROUND

Withdrawal as a method of birth control is still used in Iran. The aim of this study was to explore married women's perspectives and attitudes on withdrawal use instead of oral contraceptive (OC) in Tehran, Iran.

METHODS

This was a qualitative study. Participants were 50 married women, not currently pregnant, not desiring pregnancy and who had been using withdrawal for contraception. Face-to face interviews were conducted to collect data. Content analysis was performed to analyze the data.

RESULTS

Four major themes were extracted from the interviews: advantages, disadvantages, barriers for OC use, and husband-related factors. Advantages of withdrawal use were identified as: easy to use, convenient, ease of access, natural. Even those participants who had experienced unwanted pregnancy while using withdrawal, relied on withdrawal as their contraceptive method. Disadvantages of OC included concerns about side effects. Barriers related to use of OC included the need for medical advice, vaginal examination and daily use. Husband-related factors included: the husband wanted to be the primary decision maker on the number of children and that he preferred withdrawal.

CONCLUSION

Health providers should address misunderstandings that exist about OC and highlight the non-contraceptive health benefits of OC to balance the information provided for women. We suggest that not only women but also their spouses be advised in family planning programs.

Spiritual Job Satisfaction in an Iranian Nursing Context

This article reports the results of a qualitative study that used a deep interview method. The aim was to gather lived experiences of clinical nurses employed at government-funded medical centres regarding the non-materialistic and spiritual aspects of the profession that have had an important impact on their job satisfaction. On analysing the participants' concepts of spiritual satisfaction, the following themes were extracted: spiritually pleasant feelings, patients as celestial gifts, spiritual commitment, spiritual penchant, spiritual rewards, and spiritual dilemmas. Content analysis of the data indicated that nurses who viewed these dimensions of job satisfaction as a significant factor considered nursing as an opportunity to worship God while providing care for patients, and regarded their aim as achieving patients' contentment by providing nursing care compatible with scientific care methods.